Around April of 2015 I started to feel pain on the outside (lateral side) of my right ankle. It was a strange pain for a number of reasons, 1) it just suddenly appeared during one of my runs, 2) the level of pain would vary, ranging from dull ache to forcing-me-to-cut-runs-short pain, 3) it got progressively worse with time to the point where it felt like someone was holding a blowtorch against my ankle.
As a running coach I am all too aware of the problems that come with niggles or aches and pains that are left ignored or unattended. Most injuries start out this way and can be avoided if the niggles are addresses and dealt with early on. And although I have never suffered from plantar fasciitis I am well aware of the signs and symptoms associated with this dreaded injury. So, when I started to feel this “niggle” on the outside of my ankle I immediately applied the standard RICE (rest, ice, compression and elevation) home-treatment plan. When this failed to remedy the situation I headed off to the physio, but found no improvement. I then went to see my chiro. Following chiro treatments where he would realign my hips I noticed that I did feel some relief in the injury sight (yes, at this point I now considered this a full blown injury, I was being forced to shorten runs and even skip runs.)
Despite some relief following chiro visits, injury was showing no sign of healing up and going away. I remember one evening trying to get through a training session and halfway through, amidst much pain in the ankle, I stopped dead and decided that’s it, “I need to get to the bottom of this, I don’t know what other damage I am now causing.” I stopped running and continued to seek out medical professional help.
I had already been to one physio, and a chiro. I headed off to a second physio who looked at this thing from a different angle and suggested I had one glute weaker than the other and I needed to strengthen that up. I did so, I stuck to the strength work and did what I was told. But, that too never so much as hinted at fixing the problem. This injury had started around April/May, I was now in September and getting nowhere. Next step, one of the top Sports Physicians in the country. I sat in his office and explained the last few months to him. He examined my foot, and to his credit said to me he wasn’t sure and couldn’t see a problem, I would need to go for a MRI scan in order to rule out any stress fractures etc. Not that I ever though it could be a stress fracture, the symptoms just didn’t align.
I went for the MRI just before my birthday and then waited for the results. In the meantime, as any runner wants to do, I celebrated my birthday with a run. I wanted to go longer, but limited by birthday run to 21km’s just because I hadn’t run much in the last 3 months and because I wasn’t sure just how much damage I was doing and what I was damaging exactly. The following day I received a phone call from the Sports Physician, “Ray, I have bad news”, my heart sank, “you have a torn tendon and a stress fracture.” My worst possible fears and for a moment I had no words, then my brain kicked into gear, “but how is that possible? I know I have a high pain tolerance, but seriously? I ran 21k’s yesterday.” On hearing that I had run 21k’s he suggested that I come and see he for a further examination.
I did, he re-examined me and then said, “ok, I can’t see that you have a torn tendon, so it must be a stress fracture, you’ll need to go into a moon-boot for 6 weeks, then come and see me again.” And that what that. “A stress fracture….how is that possible?” That’s all that kept going through my mind, it seemed impossible for me to have a stress fracture and have run 21km’s, with, yes a burning pain, but not an unbearable I want to hit the roof kind of pain.
This is turning into a long story…… 🙂
Later than evening a client of mine, who happens to be an orthopedic surgeon, listened to my story and agreed with me that this did not sound like a stress fracture. Anyway, he took my MRI with him and passed it onto one of the foot specialists at the hospital. The next morning he sent me a text, two of the foot specialists at the hospital had both looked at the MRI and they could not see so much as a hint of a stress fracture. Back to square one.
In desperation I headed off to see an orthopedic surgeon I had contact with. I explained the symptoms and he immediately said, “no stress fracture.” However, when I told him that I experience some relief after seeing my chiro he turned around and said to me, “there is no way you’ll ever convince me that what happens above the knee effects anything below the knee.” I’m no surgeon, but in my limited understanding of the body, even I know that that is an extremely narrow minded view. He then turned and said to me, “I know what this is. I know exactly what this is?” I was excited, I felt like I had been jumping through hoops, and now after all this time someone eventually had an answer, “what? what is it?” I asked. “You have plantar fasciitis.” I started to laugh, I said to him, “No way, there is no way this is plantar fasciitis. I know the symptoms, I do not have the symptoms for plantar.” But, there was no convincing him otherwise, I had plantar fasciitis and that was that. I headed out of his office,not convinced in the least, but hey, I’d treat it as plantar and if it was, at least I’d be on the road to recovery. I bought myself a strassburg sock (this is a sock you put on a night which has a strap running from the top of your toes to your knee which you pull nice and tight, the idea is that you stretch out the plantar fascia while you sleep), it is the most uncomfortable thing in the world and I found myself waking up at 2am with cramps in my toes. I used this thing religiously for a full week with not so much as a hint of improvement. Just as a thought, I did not have plantar fasciitis and that’s another week wasted. Back to square one.
I made an appointment to see one of the foot specialists who had taken a look at my MRI. He examined my foot and he too could find nothing wrong. I was beginning to wonder if this pain was even real. He suggested that I go for an ultra sound examination. I made a booking and headed off to an ultra sound examination. She spent a long time, meticulously examining very mm of my foot, both left and right sides to see if she could spot any differences and the actual problem. After a long while she turned and said to me, “I’m sorry but I can’t find anything wrong. Your right plantar is slightly thicker than your left, but what I’m seeing I would expect to see in a distance runner. I think you have a nerve entrapment.” My first question to her, “so, if there’s nothing specifically wrong, can I run? I will run through pain if I need to as long as I know I’m not damaging myself.” (typical runner). I left her rooms and went for a run.
Still no answers, but starting to narrow it down.
Off to a nerve specialist who performed a nerve conductivity test on me. A very interesting examination. He seemed a little puzzled and when I asked him what he found his response was, “I’m not sure, there’s definitely something going on here, but I need to look further at the results.”
He sent the results back to the foot specialist and I followed suit He explained to me that the ultra sound and nerve conductivity test had picked up a trapped nerve but identifying which nerve was going to be a process of trial and error. The plan? I needed to find a running protocol that would cause the pain, then I would come and see him, he would numb the nerve under ultra sound and i would immediately perform the protocol to see if I felt any pain. Right, off the track, bearing in mind that I had hardly run in the last 3 months, I warmed up and then hammed 4 x 400m repeats as fast as I could with 60 seconds rest between, then to really make sure I could feel it, I followed that with 10 x 150m sprints. I had my protocol and off to ultra sound where the foot specialist and the ultra sound specialist worked together and numbed, if memory serves me correctly, the cutaneous nerve. Straight out of the rooms and down to the track to follow my protocol. It was a weird feeling, my brain felt like it was supposed to be feeling feedback coming from the nerve, but nothing. I felt nothing. This was good, I was on the right track and we had identified the nerve causing the issue.
Back to the foot specialist. “Right Doc, where to from here?” “Well, we’ll start with a cortisone jab into the spot making sure we don’t cortisone any tendon, if the cortisone doesn’t work then we’ll either cut out the nerve or deaden it.” “What??? Cut out or deaden the nerve? Surely I have a nerve there for a reason?” Anyway, we made a booking for the cortisone, I’m not a cortisone fan, but looking at my options, I didn’t feel I had any. He jabbed the cortisone into the side of my foot. Not a pleasant experience, there is no meat on the outside of your foot, just skin and bone. After he removed the needle he left me for a few minutes and out of the blue I felt like I was going to go through the roof, the pain was unbearable. Anyway, it eased off after a few minutes and I limped out of his rooms.
Over the coming weeks the cortisone appeared to have done the trick and the pain began to go. This was short lived and it wasn’t long before I was back to square one with the same burning pain. But there was no way I was going back to the surgeon to have a nerve cut out.
I had seen two physios, a chiro, a sports physician, an orthopedic surgeon, an orthopedic foot specialist, an ultra sound specialist, and a nerve specialist. Eventually I went the route I should’ve gone right in the beginning, Lynotherapy. I didn’t initially go this route as most of the Lynotherapists I had come across were also physios and they were finding it difficult to move away from the typical physio symptom based approach toward the LYNO cause and holistic approach. I wanted someone who dealt with and only did Lynotherapy, kinda like myself. Unfortunately, it is impossible to perform a LYNO treatment on yourself, but eventually I found someone who only did Lynotherapy and proceeded with a number of LYNO treatments every 4 to 5 days for a few weeks and then maintenance treatments every 4-6 weeks. After a few treatments I could feel significant improvement in my ankle (despite the fact the during the LYNO treatment my ankle was hardly touched). After 6 weeks I was back to my full training plan and the pain was completely gone.
One of the other things I found particularly interesting with the consistent LYNO treatments, and I know this sounds like an advert but it really isn’t – it’s just my story, is that with no real quality work in my week apart from one or two light tempo sessions and one longer interval session and despite having 3 months of almost no running, I was running faster, I felt like I had use of my shoulders and I felt like I could lift my legs and turn them over quicker. Off the back of this I ran a PB 10k in 33:55 (my previous PB was 35:19)
What’s my point? Often something like LYNO sounds too good to be true and is often tried as a last resort. But, it is a holistic approach at the body which enables the cause of an injury to be addressed rather than constantly struggling with recurring injury and never quite getting there. Am I saying physio and chiro are irrelevant? Not at all! I have found that a LYNO treatment and a physio or chiro treatment often work well together. If you get your fascia moving through a LYNO treatment, when a chiro manipulates you, you are more inclined to stay aligned that much longer because the fascia is not pulling your bones out of alignment. In terms of physio, an injured site responds far better to needling and physio work when fascia is not pulling into that sight and it is given the opportunity to heal.
Anyway, thanks for reading, I really just wanted to share some of my, very long, story with you 🙂